Modified Giemsa Stain: A solution to improve the quality of hypercellular bone marrow smears.

INTRODUCTION: Morphology is still the cornerstone of the diagnosis of haematological malignancies where the quality of staining plays a major role. The hypercellularity of a smear interferes with the quality of staining. We compared a newly modified giemsa stain (MGS) as a routine method for staining hypercellular bone marrow smears over the conventional Leishman method and the May Grunwald Giemsa method (MGG) in a completely randomized block study. METHODS: Quality of staining, cost, labour intensiveness and turnaround time of the new method was compared with MGG and Leishman methods for bone marrow smears of acute leukaemia using 30 cases. Bone marrow smears were blindly reviewed for the degree of staining of nuclei, cytoplasm and granules on a scale of 0 to 4 and statistically analysed by Minitab 16. RESULTS: A significant difference (p < .05) was revealed for the quality of staining of nuclei, cytoplasm and granules, and it was found that the new MGS was superior to the MGG and Leishman method. The cost of staining was lowest in the new MGS and the staining time of the new MGS was 76% less than MGG and 9.09% greater than the Leishman method. In terms of turnaround time, the new MGS is somewhat similar to the Leishman method and is user-friendly with a lesser number of steps to follow, compared with MGG. CONCLUSION: Our study showed that the new MGS is overall far superior, cost-effective and user-friendly compared with other conventional staining methods when used for hypercellular bone marrows.

Alpha thalassaemia and extended alpha globin genes in Sri Lanka.

The α-globin genes were studied in nine families with unexplained hypochromic anaemia and in 167 patients with HbE ß thalassaemia in Sri Lanka. As well as the common deletion forms of α(+) thalassaemia three families from an ethnic minority were found to carry a novel form of α(0) thalassaemia, one family carried a previously reported form of α(0) thalassaemia, --(THAI), and five families had different forms of non-deletional thalassaemia. The patients with HbE ß thalassaemia who had co-inherited α thalassaemia all showed an extremely mild phenotype and reduced levels of HbF and there was a highly significant paucity of α(+) thalassaemia in these patients compared with the normal population. Extended α gene arrangements, including ααα, αααα and ααααα, occurred at a low frequency and were commoner in the more severe phenotypes of HbE ß thalassaemia. As well as emphasising the ameliorating effect of α thalassaemia on HbE ß thalassaemia the finding of a novel form of α(0) thalassaemia in an ethnic minority, together with an unexpected diversity of forms of non-deletion α thalassaemia in Sri Lanka, further emphasises the critical importance of micro-mapping populations for determining the frequency of clinically important forms of the disease.

Laboratory identification of lupus anticoagulants.

The main laboratory characteristic of lupus anticoagulants (LA) is their ability to prolong phospholipid-dependent clotting time in vitro. The laboratory demonstration of LA requires a systematic approach combined with an awareness of the many variables that can affect test results. The ideal testing procedures are those sensitive enough to detect weak LA and specific enough so as not to produce incorrect conclusions. International guidelines have been published to assist laboratories in applying correct testing processes. The most recently published guidelines from the International Society on Thrombosis and Haemostasis update the criteria for detecting the presence of LA that were presented in the 1995 guidelines. Some of the specific recommendations relate to the key areas of setting cut-off levels for screening, mixing, and confirmatory procedures. The more challenging aspects of testing for LA include maintaining sensitivity and specificity of the assays, especially in the presence of anticoagulant therapy.